健康婴儿鼻前庭耐甲氧西林金黄色葡萄球菌定植的特点和影响因素  

Characteristics of methicillin-resistant Staphylococcus aureus colonization and related influencing factors of nasal vestibule in healthy infants

作　　者：王燕红 张彩坤[2] 王庆广 

机构地区：[1]淄博市第一医院儿保科,山东淄博255200 [2]山东中医药高等专科学校临床教研室,山东烟台264100

出　　处：《环境与职业医学》2017年第2期124-128,共5页Journal of Environmental and Occupational Medicine

摘　　要：[目的]探讨健康婴儿鼻前庭耐甲氧西林金黄色葡萄球菌(MRSA)定植特点及影响因素。[方法]以符合条件的530例婴儿为研究对象,应用自行设计的问卷调查研究对象的一般资料。于1、2、3、4、5和6月龄时在鼻前庭采集样本并进行细菌培养,观察金黄色葡萄球菌(SA)、MRSA和肺炎链球菌(SP)的定植情况。应用logistic回归分析探讨6月龄时MRSA定植的危险因素。[结果]SA定植率在1月龄时最高(128例,24.2%),并随月龄增加而下降(χ2=47.128,P<0.001);SP定植率则在1月龄时最低(20例,3.8%),并随月龄增加而升高(χ2=52.486,P<0.001);MRSA定植率在1~2月龄时最高(24例,4.5%;15例,2.8%),此后下降并趋于平稳(χ2=6.293,P=0.042)。logistic多元回归分析显示出生体重<2 500 g[OR(95%CI):1.267(1.036~3.754),P=0.042]、环境烟草烟雾暴露[OR(95%CI):1.244(1.084~4.766),P=0.045]、住院史[OR(95%CI):1.539(1.369~6.847),P=0.033]和应用抗生素[OR(95%CI):1.832(1.645~4.021),P=0.019]是影响MRSA定植的独立危险因素。[结论]健康婴儿在出生后前6个月的早期较晚期有较高的MRSA定植率。低出生体重、有住院史、存在环境烟草烟雾暴露和应用抗生素是MRSA定植的独立危险因素,加强医务人员手部卫生和医院消毒、严禁室内吸烟将有助于减少MRSA的定植。[ Objective ] To analyze the characteristics of methicillin-resistant Staphylococcus aureus （MRSA） colonization near nasal vestibule and factors influencing the colonization in healthy infants. [ Methods ] A total of 530 infants meeting the conditions were included. General data of the subjects were collected using selfdesigned questionnaire. Specimens from nasal vestibule were sampled and cultured at 1, 2, 3, 4, 5 and 6 months of the selected infants. Colonization of Staphylococcus aureus （SA）, MRSA, and Streptococcuspneumoniae （SP） were observed. Logistic regression analysis was used to analyze the risk factors of MRSA colonization at 6 months of age. [ Results ] SA colonization rate was highest at 1 month of age （n=128, 24.2%）, and declined gradually with age increasing （x^2=47.128, P 〈 0.001）; SP colonization rate was lowest at 1 month of age （n=20, 3.8%）, and increased gradually with age increasing （x^2=52.486, P〈 0.001）; MRSA colonization rate was highest at 1-2 months of age （n=24, 4.5%; n=15, 2.8%）, and decreased to a valley （（2=6.293, P=0.042）. The results of multivariate logistic regression analysis showed that birth weight 〈 2 500 g [OR （95%CI）： 1.267 （1.036-3.754）, P=0.042], environmental tobacco smoke exposure [OR （95%CI）： 1.244 （1.084-4.766）, P=0.045], history of hospitalization [OR （95%CI）： 1.539 （1.369-6.847）, P=0.033], and using antibiotics [OR （95%CI）： 1.832 （1.645-4.021）, P=0.019] were independent risk factors for MRSA colonization. [ Conclusion ] Healthy infants have a high rate of MRSA colonization at the early period than the late period in the first 6 months of life. Low birth weight, history of hospitalization, Environmental tobacco smoke exposure, and using antibiotics are independent risk factors for MRSA colonization. Strengthening hand hygiene of medical workers and hospital disinfection as well as strictly prohibiting smoking indoors would help reduce MRSA colonization.

关 键 词：金黄色葡萄球菌 定植 婴儿 环境烟草烟雾 低出生体重 抗生素 

分 类 号：R725.1[医药卫生—儿科]